Childhood Occupation Research Articles

Sensory modulation disorder: a risk factor for participation in daily life activities

Participation in childhood daily functional performance was examined in 78 children: 44 with sensory modulation disorder (SMD); (33 males, 11 females; mean age 7y 6mo [SD 1.20]) and 34 without SMD (18 males, 16 females; mean age 7y 8mo [SD 1.33]). Group classification was determined using two measures: the Short Sensory Profile (SSP) and the Full-form Sensory Profile. Parents completed a battery of caregiver questionnaires. Children with SMD scored significantly lower on all three participation scales than the control group. A high correlation was observed between level of activity performance of the Participation in Childhood Occupations Questionnaire (PICO-Q) and the SSP, and a moderate correlation was observed between the Enjoyment of Performance of the PICO-Q and the SSP. A low correlation was observed between Frequency of Performance of the PICO-Q and the SSP. Logistic regression indicated that all three participation scales (level of activity performance, level of enjoyment of the activity, and frequency of performance of the activity) are significantly associated with group classification, with odds ratios of 3.13, 2.05, and 1.73 respectively. These findings are the first, to our knowledge, to confirm claims of limited participation in daily activities among children with SMD. Our results have significant clinical implications and provide support for the need for practitioners and caregivers of children with SMD to facilitate participation.

An Occupational Perspective on the Assessment of Social Competence in Children

Maintaining relationships and interacting socially are essential aspects of the occupational performance of childhood and adolescence. Social participation occurs during many childhood occupations, such as play and school work. Occupational therapists assess and treat children with difficulties in social participation. Rather than assessing a child's social skills deficits in isolation, the use of occupation-based theoretical models guides clinicians to consider the individual in his or her environments and during occupations. Familiarity with existing models of social competence and available assessment tools provides occupational therapists with the basis for a comprehensive assessment of children. This paper presents an occupational therapy model (the Model of Human Occupation), models of social competence from cognate fields and a range of assessment tools in order to guide occupational therapists in assessing and treating children with social participation difficulties in a more occupation-centred manner. The paper also presents a rationale for the use of multiple methods for a comprehensive assessment of a child's social competence.

Exploring Ordinary Childhood Occupations Through Community Partnerships

Exploring Ordinary Childhood Occupations Through Community Partnerships

The Play of Children with Special Needs in Mainstream and Special Education settings

EDUCATORS AND OCCUPATIONAL THERAPISTS regard play as a primary occupation of childhood, which in the case of children with special needs has not been well studied. The aim of this descriptive study was to observe the free-play behaviour of children with special needs in both special education and mainstream education settings. The Revised Preschool Play Scale and Lunzer Scale of Organisation of Play Behaviour were used to observe and record short play samples of 12 children with special needs, aged 48 to 84 months, in both educational settings. Results suggest that developmental play skills remained constant between the two settings. This study highlights the strong developmental foundations provided by play as well as advocating for the importance of play assessment in school-based therapy.

Exploring Ordinary Childhood Occupations Through Community Partnerships

The purpose of this paper is to discuss an innovative assignment, The Occupational Outline and Disability Status Report, and to describe how a community-academic partnership was formed. Community-academic collaborations provide students with the opportunity to observe children in natural environments. This partnership facilitates the development of clinical reasoning skills necessary for pediatric practice in community settings. Through observation of ordinary childhood occupations at a children's museum and a written assignment, students identify the significance of play and social participation while hypothesizing about the influence of impairments on performance.

An Occupation-Centered Discussion of Development and Implications for Practice

Children's learning to do everyday activities seems so obvious that the mechanisms bringing about the development of occupations remain essentially unstudied. Therefore, occupational therapy uses developmental models from other disciplines as foundation for practice. We specialists in childhood occupations need a theory-based and empirically tested body of knowledge about the processes leading to change to inform practice and guide interventions during efficacy studies. One body of knowledge about developmental mechanisms views change as originating from within the child and informs practice centered on changing the child. Given the inseparable nature of children and their social environments and daily activities, we introduce the philosophy of contextualism and outline a potential body of knowledge about a change process that is occupation centered. An intervention arising from a contextual perspective illustrates how this way of thinking leads to occupation-centered practice that uses multiple strategies and supports a child's occupation with social participation with peers.

Play behaviours and play object preferences of young children with autistic disorder in a clinical play environment

Play is the primary occupation of childhood and provides a potentially powerful means of assessing and treating children with autistic disorder. This study utilized a cross-sectional comparison design to investigate the nature of play engagement in children with AD (n = 24), relative to typically developing children (n = 34) matched for chronological age. Play behaviours were recorded in a clinical play environment. Videotapes comprising 15 minutes of the children's spontaneous play behaviour were analysed using time-interval analysis. The particular play behaviours observed and play objects used were coded. Differences in play behaviours (p < 0.0001) and play object preferences (p < 0.0001) were identified between the groups. Findings regarding play behaviour contribute to contention in the literature surrounding functional and symbolic play. Explanations for play object preferences are postulated. Recommendations are made regarding clinical application of findings in terms of enhancing assessment and intervention by augmenting motivation.

Playfulness in Children with Traumatic Brain Injury

The sequelae of paediatric traumatic brain injury (TBI) are well documented as being permanent and pervasive. The impact, however, on how a child approaches the childhood occupation of play, termed 'playfulness,' has been neglected. This prospective analysis of difference study used the Test of Playfulness to compare the playfulness of eight children aged 3-13 years diagnosed with moderate to severe TBI to an age-matched control group. Using Rasch analysis, the TBI group did demonstrate the behaviour of playfulness, but to a significantly lower extent than the control group (Wilcoxon matched-pairs signed-ranks (T(8) = 0, p= .012). The findings suggest that playfulness is negatively impacted by TBI, and that strategies to legitimise and optimise playfulness be incorporated into therapy practice for this population.

Editor's choice

Last year we discussed off-label tocolytics. This month we have twocommentaries on misoprostol, another drug often used controversially outside its licensed indications. Marsden Wagner argues (pp. 266–268) against misoprostol as a cervical ripening agent on the grounds that it has not been properly evaluated, and that other licensed drugs are available, while a group of medical campaigners with links to developing countries, argue (pp. 269–272) that it should be used more widely. Their claim is based largely on cost. Misoprostol is cheaper than alternative prostaglandins, although whether this reflects lack of safety evaluation in pregnancy, or a genuinely lower market price because of a more favourable balance between supply and demand, is debatable. The advocates of off-label misoprostol also emphasise its place in abortion or to control post partum haemorrhage, rather than to induce labour. Despite the lack of a licence, the evidence-base for the former indications is relatively strong. For 20 years British paediatricians have notified new cases of a panel of topical but rare childhood conditions to a central office each month. Although it has been a dramatically successful research tool, obstetricians have until now relied on ad hoc surveys, such as the BEST one of eclampsia in 1992. We are now following the paediatricians' lead with the launch of the United Kingdom Obstetric Surveillance System (UKOSS) (pp. 263–265). The proportion of hysterectomy operations performed by the vaginal route varies widely between regions and hospitals according to a survey from the Doctor Foster unit at Imperial College (pp. 326–328). The variation, which was not explained by difference in case mix, is likely to come under close scrutiny in future as the NHS moves towards paying hospitals according to a tariff for work undertaken. If, as the authors claim, the vaginal route is really quicker and safer, managers will have to encourage it. Some people doubt the wisdom of allowing this sort of commercial pressure to influence doctors' decisions but at least the new system will create an incentive for hospitals to collect accurate statistics. On pages 329–333 a group from Kent report a randomised controlled trial of a newish haemostastic device at vaginal hysterectomy. The Ligasure instrument uses controlled pressure and electro-coagulation to occlude the sort of larger vessels which would normally require ligation. The trial confirms that operative time is reduced with the use of the new device, but was too small to estimate relative safety. Audit and case control studies are probably better at evaluating that. Fetal fibronectin in vaginal secretions is a good predictor of pre-term delivery (pp. 293–298). The authors of the present study revealed the results to patients which would have compromised their estimate of test accuracy if treatment had been given, but which gave them the opportunity to measure the resulting patient anxiety. Patients with a positive result at 24 weeks were more anxious, and justifiably so, since nearly half of them were delivered before 30 weeks. Fortunately few other women, outside research projects, need be made anxious, because we have no effective treatment for high risk of preterm labour. Open myomectomy, the conventional treatment for women with symptomatic fibroids who wish to retain fertility, is a major operation with high morbidity. On pages 340–345 Adam Magos and his colleagues from the Royal Free in London report a randomised trial of the use of three haemostatic tourniquets during the operation, one of which was left in situ. The effect on blood loss and need for transfusion was dramatic, although the difference was largely due to a higher than expected blood loss in the control group. There appeared to be no obvious alteration in ovarian function post operatively, but the results of fertility follow-up are awaited. Fibroid embolisation also potentially retains fertility. On pages 321–325 the group from Guildford, with perhaps the most experience in the UK, report the outcome for 26 pregnancies in 22 women. The high rate of preterm delivery was also seen in other series, and the high rate of caesarean section may owe as much to the age of the mothers and their previous history as to the embolisation itself. Social deprivation in adulthood is associated with early menopause, although the effect may be mediated by smoking. On pages 346–354 Hardy and Kuh use data from the Medical Research Council's National Survey of Health and Development to investigate early-life influences. Such factors as parental divorce and having a father in a manual occupation in childhood are more strongly associated with early menopause than later-life stress, and the association is independent of later-life behavioural factors.

Children's work: the less-considered childhood occupation.

Children's work has largely been overlooked by researchers of many disciplines due to sociohistorical trends that fostered the notion that childhood should be a time free of work. Likewise, it has received little attention in occupational therapy most likely due to the influence of these historical developments on occupational therapy rhetoric and values. This paper begins by describing the influence of child labor laws and reformation on children's participation in work. Next, using a comprehensive review of the literature gathered from social sciences, a critical examination of the historical and current research on children's work is provided. This synthesis is framed in concepts of occupational science analyzing the evidence that describes the nature, form, function, and meaning of children's work. For occupational therapists working with children with disabilities, this research provides beginning guidelines for occupation-based work interventions and typical expectations for nondisabled children that may be applied using clinical reasoning to populations with disabilities.

Occupational performance challenges for children with congenital heart disease: a literature review.

Paediatric specialists have advocated for exercise training programs for children with congenital heart disease without addressing other common deficits, such as behavioural and psychological problems. Despite evidence of the role of occupational therapy in rehabilitation for adults with cardiac disease, there has been little published about occupational therapy for children with congenital heart disease. This literature review on the outcomes of congenital heart disease, guided by the Canadian Model of Occupational Performance, highlights the comprehensive needs of these children. The findings of the review are that congenital heart disease can have wide-ranging neurological and psychosocial implications. This suggests that occupational therapists should be concerned about limitations in the participation of these children in age-appropriate childhood occupations related to self-care, productivity or leisure. As cardiac rehabilitation program planning becomes more commonplace for children, comprehensive programs that promote optimal occupational performance need to be developed, implemented and evaluated.

Perceptions of Play and Leisure in Junior School Aged Children with Juvenile Idiopathic Arthritis: What are the Implications for Occupational Therapy?

Play is the dominant occupation in childhood and is recognised as having an important role in wellbeing. Past research suggests that children with a disability experience a variety of barriers to engagement in play. Despite this, play is often not assessed as a specific area of occupational performance. This qualitative study aimed to explore the perceptions of play and leisure in junior school aged children with juvenile idiopathic arthritis. Twelve children between the ages of 7 years and 11 years were interviewed in order to uncover the barriers to engagement in play and leisure and to consider the implications, if any, for occupational therapy. The results showed that all children, regardless of disease activity, reported difficulty in engaging in play and leisure activities. The symptoms of the disease, the treatment regimes and their side-effects, and psychosocial factors were all reported to affect play and leisure experiences. The children also reported that play behaviours were often restricted by parents, friends and school personnel. Fear of damage and unclear communication about the effects of activity also resulted in self-imposed restrictions, which further limited play experiences. Although the children reported a number of coping strategies to deal with these difficulties, they reported more indoor play and engagement in sedentary activities which often gave rise to feelings of being different, sadness and loneliness. These findings may have important consequences for occupational therapy and provide a timely reminder about the significance of assessing play and leisure as distinct areas of occupational performance in children.

The Significance of Being Occupied: The Social Construction of Childhood Occupations

The purpose of this paper is to explore theoretical and developmental foundations for interpreting childrens hood engagement with activity in the typically social worlds of childhood. Drawing upon longitudinal ethnographic children data, I argue for the need to reframe the study of childhood occupation to the study of "socially occupied beings" as a means of enhancing our understanding of children's experiences. The focus is on childhood experiences that are socially constructed through adult and child co-created action sequences. The unit of analysis is constructed around a child or children, their adult partners in action, the social world of engagement, and proposed the cultural context. The interpretive focus is on acts and actors, acting in a socially constructed world. Two pation, microethnographic examples are provided; the first relates to an observation of a mother and her children playing in a hospital corridor and the second to an occupational therapist and child engaged in jointly constructed activity within a therapy session. These segments illustrate pragmatic and conceptual understandings of the interconnectedness of social relatedness, intersubjectivity, social action, and engagement. Further development of theoretical and research models is needed to capture the essence of children as socially occupied beings, doing something with someone else that matters.

Discriminative Validity of the Motor-Free Visual Perceptual Test Revised in Children with and without Learning Disabilities

Children who encounter difficulties in the major childhood occupation of academic learning are often identified as having learning disabilities. The Motor-Free Test of Visual Perception Revised (MVPT-R) is a standardized assessment frequently used by occupational therapists to measure a child's visual perceptual skills that contribute to successful learning. Although the MVPT-R has been revised with additional normative data and test items, no validity studies using different populations have been reported. The present study investigated the ability of the MVPT-R to differentiate between children with learning disabilities and matched control children. Two groups of 38 children (7–10 years of age) were compared on their MVPT-R scores. Results of t-test analyses showed children with learning disabilities: 1) scored significantly lower on MVPT-R raw (p = 0.01), perceptual quotient (p = 0.005), and perceptual age (p = 0.02) scores, and 2) had a significantly greater percentage of children scoring below criterion cutoff than control children.

An Introduction to Play and the Preschool Child with Autistic Spectrum Disorder

As the main occupation of childhood, play is considered by occupational therapists as an important vehicle for the assessment and treatment of preschool children. For the child with autistic spectrum disorder (ASD), play not only offers a mechanism whereby the severity of the disorder can be ascertained but also enables interventions to be implemented and monitored. This paper aims to summarise the current literature as it relates to the play of children with ASD. By doing so, it alerts the reader to the complexity of the issue of play as a means of assessment and intervention and highlights areas of continuing clinical and research concern.

Development of an assessment to identify play behaviours that discriminate between the play of typical preschoolers and preschoolers with pre-academic problems.

Occupational therapists regard play as the primary occupation of childhood. However, many authors of play assessments have viewed play either as a functional outcome of other skills or as an indication of the child's developmental level. While such views of play are valid, these approaches to play are broad and do not fully consider the cognitive value of play. A study was undertaken with 82 preschoolers to see if a new play assessment which considers cognitive play skills, called the Child-initiated Pretend Play Assessment, (ChiPPA), possessed acceptable inter-rater reliability, and could discriminate between the play of typically developing preschoolers and preschoolers with pre-academic problems. This assessment evaluates preschoolers' elaborate imaginative actions, number of imitative actions, and number of object substitutions. The ChiPPA was found to have excellent inter-rater reliability and did discriminate between children who were typically developing and children who experienced pre-academic problems. In particular, the elaborateness of a child's play actions and the child's ability to substitute objects were strong discriminators of preschoolers with and without pre-academic problems. Three play profiles which emerged from the research are discussed.

Development of an assessment to identify play behaviours that discriminate between the play of typical preschoolers and preschoolers with pre-academic problems

Occupational therapists regard play as the primary occupation of childhood. However, many authors of play assessments have viewed play either as a functional outcome of other skills or as an indication of the child's developmental level. While such views of play are valid, these approaches to play are broad and do not fully consider the cognitive value of play. A study was undertaken with 82 preschoolers to see if a new play assessment which considers cognitive play skills, called the Child-Initiated Pretend Play Assessment, (ChIPPA), possessed acceptable inter-rater reliability, and could discriminate between the play of typically developing preschoolers and preschoolers with pre-academic problems. This assessment evaluates preschoolers’ elaborate imaginative actions, number of imitative actions, and number of object substitutions. The ChIPPA was found to have excellent inter-rater reliability and did discriminate between children who were typically developing and children who experienced pre-academic problems. In particular, the elaborateness of a child's play actions and the child's ability to substitute objects were strong discriminators of preschoolers with and without pre-academic problems. Three play profiles which emerged from the research are discussed.

The impact of child abuse on children's play: a conceptual model

AbstractThe purpose of this article is to examine critically the impact of child abuse on children's play, using a descriptive model of children's play as a conceptual framework for this review of the literature. Play is recognized as a primary occupation of childhood by occupational therapists. When a child is exposed to an abusive or neglectful care environment his or her play development may be disrupted. Although the detrimental effects of physical, sexual or emotional abuse and neglect are well documented, relatively few studies have investigated the play of abused children. Reported effects suggest that abused or neglected children are more likely to show developmentally delayed play skills, decreased playfulness and behavioural disturbance in their play, which may place them at greater risk for learning and social problems. Occupational therapists often use play, including play therapy, to assess and treat abused children. This analysis highlights the need for occupational therapists to evaluate how play‐based therapeutic approaches can best meet the developmental and emotional needs of abused and neglected children. Recommendations are made for occupational therapists to be more knowledgeable about child abuse and to address the need for research into the specific effects of child abuse on children's play. Copyright © 2000 Whurr Publishers Ltd.

Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men. The Honolulu-Asia aging study.

Cardiovascular risk factors often cluster into a metabolic syndrome that may increase the risk of dementia. The objective of the present study was to assess the long-term association between clustered metabolic cardiovascular risk factors measured at middle age and the risk of dementia in old age. This prospective cohort study of cardiovascular disease was started in 1965 and was extended to a study of dementia in 1991. The subjects were Japanese-American men with an average age of 52.7+/-4.7 (mean+/-SD) years at baseline. Dementia was diagnosed in 215 men, according to international criteria, and was based on a clinical examination, neuropsychological testing, and an informant interview. The z scores were calculated for 7 risk factors (random postload glucose, diastolic and systolic blood pressures, body mass index, subscapular skinfold thickness, random triglycerides, and total cholesterol). The relative risk (RR [95% CI]) of dementia (subtypes) per 1 SD increase in the sum of the z scores was assessed after adjustment for age, education, occupation, alcohol consumption, cigarette smoking, and years of childhood lived in Japan. The z-score sum was higher in demented subjects than in nondemented subjects, indicating a higher risk factor burden (0.74 versus -0.06, respectively; P=0. 008). Per SD increase in the z-score sum, the risk of dementia was increased by 5% (RR 1.05, 95% CI 1.02 to 1.09). The z-score sum was specifically associated with vascular dementia (RR 1.11, 95% CI 1.05 to 1.18) but not with Alzheimer's disease (RR 1.00, 95% CI 0.94 to 1.05). Clustering of metabolic cardiovascular risk factors increases the risk of dementia (mainly, dementia of vascular origin).

Prenatal carcinogenesis. An Appraisal

Prenatal carcinogenesis. An Appraisal